First human surgery using a surgical assistance robotics device for laparoscopic cholecystectomies.

BACKGROUND: Over the past 20 years, surgeons involved in soft tissue minimally invasive surgery have experienced the pros and cons of both conventional and tele-robotic laparoscopic approaches. The Maestro System, developed by Moon Surgical (Paris, France) aims to overcome the challenges inherent to both approaches thanks to a new concept that augments the surgeon's performance at the bedside during a laparoscopic procedure. METHODS: The current study aims to present the first human experience with laparoscopic cholecystectomy with the Maestro system on 10 patients. RESULTS: All ten procedures were completed successfully. No significant complications related to the use of the Maestro system werenoted. CONCLUSION: Our preliminary observations appear to support the benefits of the Maestro system in non-emergent laparoscopic cholecystectomies. It goes without saying that further research is necessary to demonstrate the safety of this approach in other procedures.

Evaluation of the SafeHeal Colovac+ anastomosis protection device after low anterior resection for rectal cancer: the safe anastomosis feasibility evaluation (SAFE) 2019 trial.

BACKGROUND: Protective ileostomy (PI) is the current standard of care to protect the anastomosis after low anterior resection (LAR) for rectal cancer, but is associated with significant morbidity. Colovac is an anastomosis protection device designed to shield the anastomosis from fecal content. A second version (Colovac+) was developed to limit the migration risk during the implantation period. The objective of this clinical trial was to evaluate the preliminary efficacy and safety of the Colovac+. METHODS: This was a prospective, multicenter, pilot study aiming to enroll 15 patients undergoing LAR with Colovac+ placement. After 10 days, a CT scan was performed to evaluate the anastomosis and the Colovac+ was retrieved endoscopically. During the 10-day implantation and 3-month follow-up period, we collected data regarding predefined efficacy and safety endpoints. The primary endpoint was the rate of major (Clavien-Dindo III-V) postoperative complications related to the Colovac+ or LAR procedure. RESULTS: A total of 25 patients were included (68% male), of whom 15 were consecutively treated with the Colovac+ and Vacuum Loss Alert System. The Colovac+ was successfully implanted in all 15 patients. No major discomfort was reported during the implantation period. The endoscopic retrieval was performed in 14/15 (93%) patients. The overall major postoperative morbidity rate was 40%, but none of the reported complications were related to the Colovac+. A device migration occurred in 2 (13%) patients, but these were not associated with AL or stoma conversion. Overall, Colovac+ provided effective fecal diversion in all 15 patients and was able to avoid the PI in 11/15 (73%) patients. CONCLUSIONS: Colovac+ provides a safe and effective protection of the anastomosis after LAR, and avoids the PI in the majority (73%) of patients. The improved design reduces the overall migration rate and limits the clinical impact of a migration.

Feasibility and Safety Study of the Use of a New Robot (Maestro™) for Laparoscopic Surgery.

BACKGROUND: In laparoscopic surgery, telerobotic systems such as Da Vinci™ were developed, among other things, to give back exposure and vision control to the operating surgeon. However, new limitations such as the separation of the operating surgeon from the operating table, cost, and size were unveiled. A new device, Maestro™, appears promising in addressing these limitations. The current work evaluates the feasibility, safety, and surgeon satisfaction with the assistance provided by the Maestro System. METHODS: Non-consecutive patients who were candidates for laparoscopic digestive surgery were enrolled in a descriptive prospective, monocentric study. Case selection was solely based on the availability of the device, but not on the patient's characteristics. Surgery was performed by a leading surgeon with the help of one less experienced surgeon. Feasibility was defined by the maintenance of the initial surgical plan. Safety was assessed by the absence of serious adverse events related to the device and surgeon satisfaction was evaluated by a questionnaire following the intervention. RESULTS: All 50 procedures were completed without conversion in laparotomy and without adjustment of the surgical team. Four complications were recorded during the study; however, none related to the use of the Maestro System. In 92% of the cases, the surgeon was satisfied with the assistance provided by the Maestro System. CONCLUSIONS: In standard elective digestive procedures by laparoscopy, the use of the Maestro System is feasible and safe. It is beneficial to the surgeon and operative room organization by limiting the size of the surgical team.

Sleeve gastrectomy with duodenoileal bipartition using linear magnets: feasibility and safety at 1-year follow-up.

BACKGROUND: Single-anastomosis metabolic/bariatric surgery procedures may lessen the incidence of anastomotic complications. This study aimed to evaluate the feasibility and safety of performing side-to-side duodenoileal (DI) bipartition using magnetic compression anastomosis (MCA). In addition, preliminary efficacy, quality of life (QoL), and distribution of food through the DI bipartition were evaluated. METHODS: Patients with a body mass index (BMI) of ≥35.0 to 50.0 kg/m2 underwent side-to-side DI bipartition with the magnet anastomosis system (MS) with sleeve gastrectomy (SG). By endoscopic positioning, a distal magnet (250 cm proximal to the ileocecal valve) and a proximal magnet (first part of the duodenum) were aligned with laparoscopic assistance to inaugurate MCA. An isotopic study assessed transit through the bipartition. RESULTS: Between March 14, 2022 to June 1, 2022, 10 patients (BMI of 44.2 ± 1.3 kg/m2) underwent side-to-side MS DI. In 9 of 10 patients, an SG was performed concurrently. The median operative time was 161.0 minutes (IQR, 108.0-236.0), and the median hospital stay was 3 days (IQR, 2-40). Paired magnets were expelled at a median of 43 days (IQR, 21-87). There was no device-related serious advanced event within 1 year. All anastomoses were patent with satisfactory diameters after magnet expulsion and at 1 year. Respective BMI, BMI reduction, and total weight loss were 28.9 ± 1.8 kg/m2, 15.2 ± 1.8 kg/m2, and 34.2% ± 4.1%, respectively. Of note, 70.0% of patients reported that they were very satisfied. The isotopic study found a median of 19.0% of the meal transited through the ileal loop. CONCLUSION: Side-to-side MCA DI bipartition with SG in adults with class II to III obesity was feasible, safe, and efficient with good QoL at 1-year follow-up. Moreover, 19% of ingested food passed directly into the ileum.

Implications of bacteriological study in complicated and uncomplicated acute appendicitis.

Purpose: Bacteriological sample in the presence of intraabdominal free fluid is necessary to adapt the antibiotherapy and to prevent the development of resistance. The aim was to evaluate the differences between uncomplicated (UAA) and complicated acute appendicitis (CAA) in terms of bacterial culture results and antibiotic resistance, and to evaluate the factors linked with CAA. Methods: We performed a single-center, retrospective observational study of all consecutive patients who presented with appendicular peritonitis and underwent emergent surgery in a tertiary referral hospital in Brussels, Belgium, between January 2013 and December 2020. The medical history, parameters at admission, bacterial culture, antibiotic resistance, and postoperative outcomes of 268 patients were analyzed. UAA was considered catarrhal or phlegmonous inflammation of the appendix. CAA was considered gangrenous or perforated appendicitis. Results: Positive microbiological cultures were significantly higher in the CAA group (68.2% vs. 53.4%). The most frequently isolated bacteria in UAA and CAA cultures were Escherichia coli (37.9% and 48.6%). Most observed resistances were against ampicillin (28.9% and 21.7%) and amoxicillin/clavulanic acid (16.4% and 10.5%) in UAA and CAA, respectively. A higher Charlson comorbidity index, an elevated white blood cell count, an open procedure, and the need for drainage were linked to CAA. Culture results, group of bacterial isolation, and most common isolated bacteria were not related to CAA. Conclusion: CAA presented a higher rate of positive cultures with increased identification of gram-negative bacteria. Bacterial culture from the peritoneal liquid does not reveal relevant differences in terms of antibiotic resistance.

Impact of the COVID-19 Pandemic and Lockdown on Gastric Bypass Results at 1-Year Follow-up.

PURPOSE: The COVID-19 pandemic caused a lockdown in many countries, which induced negative dietary habits and sedentary behavior. Studies suggest that weight loss of patients undergoing bariatric surgery was equally affected. The aim was to evaluate the impact of COVID-19 on weight loss, obesity-related comorbidities, and nutritional status at 1-year follow-up after gastric bypass (GB). METHODS: Retrospective observational case-control study of patients undergoing primary GB in a tertiary referral Belgian center. COVID-19 period group was composed by those whose 1-year postoperative period was affected by the COVID-19 pandemic and lockdown: from October 1, 2019, to March 31, 2020. The control group was composed of patients operated from October 1, 2018, to March 31, 2019. Electronic clinical records were reviewed searching: baseline characteristics, weight and comorbidities evolution, and biochemical values. RESULTS: A total of 47 patients in the COVID-19 period group and 66 in the non-COVID-19 period group were analyzed. There were no significant differences in baseline characteristics. A reduced weight loss was observed at 1-year follow-up, in terms of percentage of excess weight loss (%EWL) (82.4% [SD: 21.6] vs. 82.4% [SD: 21.6]; p: 0.043) and body mass index (BMI) (27.8 kg/m2 [IQR: 25.8-30.0] vs. 26.2 kg/m2 [IQR: 24.6-28.6]; p: 0.029) for COVID-19 period group vs. non-COVID-19 period group, respectively. There was a similar reduction of obesity-related comorbidities, without clinically significant differences in the nutritional follow-up. CONCLUSION: The COVID-19 pandemic and lockdown had an impact on weight loss at 1-year follow-up after gastric bypass.

Comparison of Laparoscopic Splenectomy Outcomes for Benign and Malignant Hemopathies.

Background: Laparoscopic splenectomy for malignant hemopathies has been associated with a higher morbidity than for benign hemopathies. Recent progress in medical and surgical treatment for malignant hemopathies may have improved the outcomes of laparoscopic splenectomy. The purpose of this study is to compare the outcomes of laparoscopic splenectomy for malignant hemopathies (SHM) and benign hemopathies (SHB). Materials and Methods: We retrospectively reviewed all patients with hematological diseases who underwent a non-post-traumatic laparoscopic splenectomy between 2008 and 2019. Patients who suffered splenectomy for a malignant and benign disease were divided into two groups and compared. Results: Fifty patients suffered a splenectomy for hematologic disorder, 19 patients for benign hemopathy, and 31 for malignant hemopathy. SHM group was significantly older, and had more history of abdominal surgery and significantly larger spleens (P < .05). There was no significant difference in terms of operative time (150 versus 146 minutes; P < .8) and blood loss (243 versus 402 mL; P < .26). Hospital stay for SHB and SHM groups was 5.4 and 7.6 days, respectively (P = .19). There was no significant difference in terms of early (10% versus 13%; P = 1) and late complications (0% versus 13%; P = .28). One conversion to open surgery and one perioperative death in each group (P = 1) were reported. Splenectomy effectiveness was 83% and 79% in benign hemopathy and malignant hemopathy groups (P = .91), respectively. Conclusions: Laparoscopic splenectomy for malignant hemopathy shows similar outcomes to laparoscopic splenectomy for benign hemopathy, despite older patients, larger spleens, and more important abdominal surgery history. Higher late morbidity rate after laparoscopic splenectomy for malignant hemopathy may justify a careful follow-up.

Long-term outcomes of laparoscopic adjustable gastric banding.

OBJECTIVE: To determine the long-term efficacy and safety of laparoscopic adjustable gastric banding (LAGB) for morbid obesity. DESIGN: Clinical assessment in the surgeon's office in 2009 (≥12 years after LAGB). SETTING: University obesity center in Brussels, Belgium. PATIENTS: A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation. INTERVENTION: Laparoscopic adjustable gastric banding. MAIN OUTCOME MEASURES: Mortality rate, number of major and minor complications, number of corrective operations, number of patients who experienced weight loss, evolution of comorbidities, patient satisfaction, and quality of life were evaluated. RESULTS: The median age of patients was 50 years (range, 28-73 years). The operative mortality rate was zero. Overall, the rate of follow-up was 54.3% (82 of 151 patients). The long-term mortality rate from unrelated causes was 3.7%. Twenty-two percent of patients experienced minor complications, and 39% experienced major complications (28% experienced band erosion). Seventeen percent of patients had their procedure switched to laparoscopic Roux-en-Y gastric bypass. Overall, the (intention-to-treat) mean (SD) excess weight loss was 42.8% (33.92%) (range, 24%-143%). Thirty-six patients (51.4%) still had their band, and their mean excess weight loss was 48% (range, 38%-58%). Overall, the satisfaction index was good for 60.3% of patients. The quality-of-life score (using the Bariatric Analysis and Reporting Outcome System) was neutral. CONCLUSION: Based on a follow-up of 54.3% of patients, LAGB appears to result in a mean excess weight loss of 42.8% after 12 years or longer. Of 78 patients, 47 (60.3%) were satisfied, and the quality-of-life index was neutral. However, because nearly 1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands (contributing to a reoperation rate of 60%), LAGB appears to result in relatively poor long-term outcomes.

Are laparoscopic gastric bypass after gastroplasty and primary laparoscopic gastric bypass similar in terms of results?

BACKGROUND: This retrospective study compares the results of primary gastric bypass (PGB) versus secondary gastric bypass (SGB) performed after gastroplasty. METHODS: Between January 2004 and August 2008, 576 consecutive patients benefited from laparoscopic gastric bypass (LGB) in our hospital. Four hundred seventy patients (81.6%) were available for full evaluation. Primary outcome measures were operative time, conversion to open surgery and mortality, hospital stay, early and late complications, reoperations, efficacy, and patient satisfaction. RESULTS: Three hundred sixty-two patients benefited from a PGB and 108 from SGB. Median preoperative BMI was 42 kg/m2 (34.8-63.5; PGB) and 39 kg/m2 (20.9-64.5; SGB; p = 0.002). Median operative time was 109 min (40-436; PGB) and 194 min (80-430; SGB; p < 0.001). There was no conversion to open surgery or mortality in either group. Median hospital stay was 4 days (3-95; PGB) and 5 days (2-114; SGB; p < 0.001). Early complications were recorded in 37 patients (10.2%) after PGB and in 24 patients (22.2%) after SGB (p < 0.001). Reoperation was necessary in 12 patients (3.3%) after PGB and in 9 patients (8.3%) after SGB (p = 0.03). Median follow-up was 35 months (12-66; PGB), and 34 months (12-66; SGB; NS). Late complications were achieved in 46 patients (12.7%) after PGB and in 33 patients (30.6%) after SGB (p < 0.001). Reoperation was necessary in 17 patients (4.7%) after PGB and in 11 patients (10.2%) after SGB (p = 0.03). Mean % EWL was 74.2% after PGB and 69.9% after SGB (NS). After PGB, 89% of the patients was satisfied, 4% neutral, and 6% unsatisfied; after SGB, 79% was satisfied, 10% neutral, and 11% unsatisfied (p = 001). CONCLUSIONS: Weight loss after PGB and SGB is not statistically significantly different. Otherwise, operative time, hospital stay, complications, and revision rate are statistically significantly higher after SGB (p < 0.001).