https://www.um.edu.mt/library/oar/handle/123456789/64066 Sat, 25 Apr 2026 08:54:40 GMT 2026-04-25T08:54:40Z https://www.um.edu.mt/library/oar/handle/123456789/64252 Title: Minimally invasive surgery of the adrenal gland : laparoscopic versus robotic approach : an observational retrospective case-control study on 141 cases Abstract: BACKGROUND. Since Gagner performed the first Laparoscopic Adrenalectomy in 1992 [1], laparoscopy has quickly become the gold standard for benign adrenal masses removal [5], providing lower complication rates, reduced operative blood loss (EBL), less perioperative pain and shorter hospital stay (LOS). However, some of the technical limitations of laparoscopy, such as the two dimensional vision, the instability of the camera, and the limitation of movements through the laparoscopic rigid instruments, makes laparoscopic adrenalectomy (LA) a chellenging procedure, affected by a steep learning curve. In the past decade robotic adrenalectomy (RA) as been described as an alternative to the laparoscopic approach, the intrinsic advantages of the robotic platform, as the three-dimensional and stable vision[6], tremor filtering, and endowristed instruments with 7 degrees of freedom, may overcome some of the the technical limitations of laparoscopy and eventually shorten the learning curve [7]. Criticism still exists towards robotic surgery; most controversial issues being related to operative times and high costs. To date, the indication to perform an adrenalectomy with a minimally invasive technique is still limited to benign pathology [8]. The aim of the study is to compare laparoscopic and robotic adrenalectomy in terms of surgical technique and short term post-operative outcomes. In this study, we will analyse a series of patients who underwent laparoscopic and robotic adrenalectomy over a period of 11 years, in which the laparoscopic surgeons gradually learned and performed robotic adrenalectomy, also we will compare both surgical technique in terms of the periopetative outcomes. MATERIALS AND METHODS. This is a retrospective observational study on 141 patients undergoing minimally invasive adrenalectomy, laparoscopic and robotic, from January 2006 to December 2017. Perioperative and postoperative outcomes included operative time, length of hospital stay, blood loss, complications, and conversions to open Operative time was analized in relation of BMI, tumor side and tumor size for both techniques. RESULTS: 80 LA and 61 RA were performed. Operative times were longer in the robotic group, this difference reached statistical significance only for right adrenalectomy. Tumor size influenced operative time in LA, but not RA. BMI did not influence operative times in both techniques. Length of hospital stay was significantly shorter in the RA group. No conversion to open was registered. No difference in post-operative complications was registered between the two techniques. CONCLUSIONS: In relation to the experience of the surgical team and the technology available, RA and LA are both safe and do not change the clinical outcomes in patients with benign adrenal lesions. RA may offer an advantage in length of hospital stay and in the treatment of large adrenal masses, expanding the indications of minimally invasive surgery. Randomized multicenter studies with larger samples are needed to further evaluate the impact of the robotic platform in adrenal surgery. Description: M.LAPAROSCOPIC SURGERY Wed, 01 Jan 2020 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/64252 2020-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/64251 Title: Mesenchymal stem cell regulation of IL-8 and MMP-1 in inflammatory states Abstract: Wound healing remains a challenge to many clinicians in spite of significant advances that have occurred in wound management in view of their significant social and economic impact on the ageing population (Velnar, Bailey and Smrkolj, 2009). During this study, an in vitro air-liquid interface wound model was set up to analyse the interactions between keratinocytes, fibroblasts and mesenchymal stem cells (MSC) and the changes in gene expression of Matrix Metalloproteinase-1 (MMP-1) and Interleukin-8 (IL-8) during wound healing with the help of growth factors. The project involved cell culturing of primary human keratinocytes and fibroblasts from skin biopsies and culturing of primary human mesenchymal stem cells from peripheral blood. Characterisation of Mesenchymal stem cells was carried out by differentiation of mesenchymal stem cells into adipocytes, osteocytes and chondrocytes, flow cytometry and quantitative Polymerase Chain Reaction (qPCR). The in-vitro wound model, using an air-liquid interface, was assembled using keratinocytes and fibroblasts embedded in a leukocyte-depleted platelet-rich plasma scaffold. Tumour Necrosis Factor-alpha (TNF-α) and Mesenchymal Stem Cells were added to the wound model. Ribonucleic acid (RNA) extraction was carried out from the wound model, followed by cDNA synthesis. The gene expression of IL-8 and MMP-1 was then measured using quantitative PCR. This project described the implementation of an innovative skin equivalent that is devoid of leucocytes and capable of supporting added cells such as MSCs. This enabled quantification of selective expression of genes, in this case, MMP-1 and IL-8 on wounding. The addition of MSCs to the wound model showed downregulation of MMP-1 and IL-8 in day 2, in keeping with the immunosuppressive phenotype of MSCs. The MSCs overcame the acute inflammatory state produced by the TNF-α and helped anticipate the immune response in the study group. A significant result was noted between day 2 and day 4 where a substantial increase in mRNA levels of IL-8 and MMP-1 was noted in the study group. In the case of IL-8, this contrasted with the results in the treated group where there was a down-regulation of IL-8 gene expression. The results showed that the role of mesenchymal stem cells is more complex than it was thought initially. Mesenchymal stem cells act as the “sensor and switcher of the immune system” (Jiang and Xu, 2019). These cells favour pro-inflammatory factors at the time of the inflammatory stage of repair and up regulate anti-inflammatory factors when the wound is healing (Iocono et al., 2000). Therefore, innovative wound therapies using mesenchymal stem cells, which promote regenerative medicine hold great potential for clinical management of problematic wounds. Description: M.SURGERY Wed, 01 Jan 2020 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/64251 2020-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/64250 Title: Immunohistochemical markers in thyroid cancer in the Maltese population Abstract: Thyroid tumours account for 90% of endocrine malignancies, however they have a favourable prognosis, accounting for a survival rate of more than 90%. Therefore, a proper and early diagnosis is crucial to improve the patients’ quality of life and prognosis and also avoid significant burden on the public health system. An overview of the epidemiology, demographics and investigations routinely used in the diagnosis of thyroid cancers was carried out. The latest guidelines regarding investigations and management were summarised and later compared and contrasted with the management of the studied cases. FNAB is currently the gold-standard investigation for thyroid nodules. The cytology provided from this investigation aids in classifying the nodule using the Bethesda System. The diagnosis of thyroid tumours is made on histological features, however the distinction between benign and malignant is not always straightforward. Due to this, immunohistochemical markers were introduced to aid in the diagnosis of thyroid carcinoma. Three of these important markers described in the literature are HBME-1, Galectin-3 and RET/PTC. HBME-1, (Hector Battifora mesothelial-1) is an unelucidated membrane antigen found in the microvilli of mesothelial cells. It has gained popularity in the past decade and has been studied to investigate its expression in benign and malignant thyroid lesions. In normal thyroid tissue there is no expression of HBME-1, however, it is overexpressed in malignant thyroid tumours especially papillary thyroid carcinoma. Galectin-3 is a protein which binds to cell surface glycoproteins and has recently received significant attention for its utility as a diagnostic marker in thyroid neoplasms. RET/PTC is a family of oncogenes arising from rearrangements in the gene on chromosome 10q, which are specific to papillary carcinomas and present in up to 77% of these tumours. The positive predictive value indicates a true positive case where there is papillary thyroid carcinoma and the markers are also positive. The negative predictive value indicates a true negative, where a case is benign and the markers do not stain. These values together with their sensitivity and specificity were calculated for all markers. The commonest type of thyroid carcinoma was found to be papillary thyroid carcinoma both in 2008 and 2013. In 2013, the number of ultrasounds and FNAB increased with a subsequent increase in diagnosis of papillary thyroid microcarcinoma. Both Galectin-3 and HBME-1 were found to stain significantly in papillary thyroid carcinoma, making them useful markers in diagnosing this type of thyroid carcinoma. Description: M.SURGERY Wed, 01 Jan 2020 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/64250 2020-01-01T00:00:00Z