RESUMO
INTRODUCTION: The key benefits of robotics are improved precision and control, thanks to fully articulated robotic instruments and enhanced, stable endoscope control. However, colorectal procedures also require large movements such as medialization of the colon where a robotic platform is not always needed. We present the world's first experience in colorectal surgery with a new open platform of on-demand robotics. METHODS AND PROCEDURES: Standard laparoscopic 3-D camera, insufflator, trocars and energy devices, available in all hospitals performing laparoscopic surgery, are used in combination with the Dexter System™ from Distalmotion SA, which includes two robotic instrument arms, one robotic endoscope arm and a sterile surgeon console. We present the first 12 colorectal cases of robotic assisted ventral mesh rectopexy (n = 2), oncologic right colectomies (n = 8), transverse colectomy (n = 1) and ileocecal resection (n = 1) using the Dexter System. RESULTS: The two ventral mesh rectopexies were fully robotic, requiring no switching from standard laparoscopy to robotic assistance. The robotic platform was used for central vascular ligation (CVL) in all 8 oncologic colectomies, whereas medialization of the colon and transection was performed with standard laparoscopy. The switch from laparoscopy to robotics and back was performed in 15-30 s. Intracorporal anastomosis was performed in 4 patients (stapling by standard laparoscopy and suturing of the defect with robotic assistance). Conversion or permanent switch to standard laparoscopy was required in two patients due to visceral obesity. No robotic platform-related intraoperative adverse event occurred. No major morbidity occurred at 60 days. CONCLUSIONS: On-demand robotics is feasible and combines the best of two worlds: Robotics where precision and enhanced dexterity are required and standard laparoscopy where it is at its best. The surgeon remains scrubbed-in at all times, allowing a switch between robotics and laparoscopy within seconds.
Assuntos
Neoplasias Colorretais , Cirurgia Colorretal , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Estudos de Viabilidade , Robótica/métodos , Colectomia/métodos , Laparoscopia/métodos , Neoplasias Colorretais/cirurgiaRESUMO
Acute cholecystitis is an inflammation of the gallbladder most often related to gallstones. The diagnostic and severity criteria are well described by the Tokyo criteria. Early laparoscopic cholecystectomy remains the treatment of choice. It can also be performed in elderly patients and in pregnant women during any trimester. For patients not eligible for surgery, percutaneous or echo-endoscopic gallbladder drainage (EUS-GBD) are effective treatment alternatives. The management of acute cholecystitis must therefore be adapted to each patient by carefully evaluating the risks and benefits associated with surgery.
La cholécystite aiguë est une inflammation de la vésicule biliaire le plus souvent liée à des calculs biliaires. Les critères diagnostiques et de sévérité sont bien décrits par les critères de Tokyo. La cholécystectomie laparoscopique précoce reste le traitement de choix. Elle peut être également réalisée chez les patients âgés et chez les femmes enceintes pendant n'importe quel trimestre. Pour les patients non éligibles à la chirurgie, les drainages de la vésicule biliaire par voie percutanée ou échoendoscopique (EUS-GBD) sont des alternatives thérapeutiques efficaces. La prise en charge de la cholécystite aiguë doit donc être adaptée à chaque patient en évaluant de façon attentive les risques et bénéfices associés à la chirurgie.
Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Cálculos Biliares , Gravidez , Idoso , Humanos , Feminino , Colecistite Aguda/diagnóstico , Colecistite Aguda/terapia , Inflamação , Drenagem , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico , Cálculos Biliares/terapiaRESUMO
Obesity is a major health problem with a prevalence that has tripled since 1976, affecting a large portion of the population across all ages. Bariatric surgery is currently considered as the most efficient and durable treatment in terms of weight loss and remission of long-term co-morbidities. The objective of this article is to describe briefly the different surgical options for patients with severe obesity and to report their effectiveness, as well as to provide primary care physicians with simple instructions, regarding initial management and the appropriate guidance of their patients to a specialized service.
L'obésité représente un problème de santé publique majeur avec une prévalence qui a triplé depuis 1976 et qui touche une grande partie de la population, tous âges confondus. La chirurgie bariatrique est actuellement considérée comme le traitement le plus efficace et le plus durable en termes de perte de poids et de rémission des comorbidités à long terme. L'objectif de cet article est de décrire brièvement les différentes options chirurgicales pour les patients souffrant d'une obésité sévère, de rapporter leur efficacité, ainsi que de fournir aux médecins de premier recours des instructions simples en ce qui concerne la prise en charge initiale et l'orientation appropriée de leurs patients vers un service spécialisé.
